Maria Ramirez went to work one day last June just like any other day. But about two hours into her shift, she started to feel extreme pressure in her neck and head. Soon she began vomiting and an ambulance was called. Maria had suffered a ruptured brain aneurysm, a life-threatening condition that requires surgery to stop the bleeding and relieve the pressure on the brain.

A brain aneurysm is an abnormal bulge on the side of the artery wall. The artery carries blood and pressure on the wall can cause the bulge to rupture, allowing blood to flow out of the vessel into the brain.

"About 20 percent of the time a ruptured aneurysm is immediately fatal, and many patients are neurologically injured or die later because of severe brain injury," said Dr. Jeffrey Thomas, a cerebrovascular neurosurgeon and medical director of Interventional Neuroradiology at Washington Hospital. "A rupture puts people in great danger and they need to get to a specialized hospital for treatment immediately."

Maria, who lives in Modesto, was taken to a nearby medical center, where a physician diagnosed the ruptured brain aneurysm. There she was referred to Thomas, one of only about 120 neurosurgeons in the United States with dual expertise in microscopic brain surgery and interventional neuroradiology. It was thought that she could benefit from a range of potential therapies at Washington Hospital, including a less invasive procedure that Thomas performs.

Five hours after she arrived at the medical center, Maria was flown by helicopter to Washington Hospital, where she was met by Thomas and a team of specialists.

"At Washington Hospital, we have personnel with high-level expertise in all aspects of neurosurgery, including a neurophysiology monitoring team and neurocritical care specialists," he explained. "You don't usually see this type of specialized care at a community hospital. We also have a new state-of-the-art surgical suite, where we performed Maria's surgery."

The new surgical suite features a BodyTom(r) portable CT scanner, making it one of only three hospitals in the entire country to have one. The BodyTom(r) provides three-dimensional images of the body right in the operating room.

Repairing the Damage

Maria had suffered a very large hemorrhage and a lot of blood had surrounded her brain, Thomas said. He determined that the best course of action was to repair the rupture with conventional microscopic brain surgery rather than the newer less invasive technique.

With the newer technique, a tiny microcatheter is introduced into the leg and guided through a series of blood vessels into the chest, through the aorta, and into the head and brain, Thomas explained. A soft platinum wire is pushed through the microcatheter and into the aneurysm. The wire coils up inside the aneurysm, stops the blood flow, and causes the blood to clot. Called coiling, this procedure requires no opening of the skull.

With the conventional microsurgery that Maria received, Thomas removed part of her skull, located the blood vessel that was feeding the aneurysm, and closed it off using a tiny titanium clip. During the delicate brain surgery, the team of specialists monitored her brain waves to ensure that no damage was being done to her brain.

"When you have a patient with this much hemorrhaging, pressure builds up in the brain," he said. "The pressure can cause the brain to swell. All of the other blood vessels start to clamp down, not just the one with the aneurysm. Often patients get very sick a few days after surgery and can die even though the surgery was successful. But by removing the skull, it helped to alleviate the pressure, and Maria never got terribly sick."

Maria spent 18 days in the intensive care unit at Washington Hospital receiving neurocritical intensive care, and nearly a month in the hospital recovering. Throughout the entire ordeal, her husband and other family members kept vigil.

"From the moment I got the call something happened to her at work, I was worried," her husband Raul Ramirez said. "But I am really happy with the care she received at Washington Hospital."

Maria is still recovering, but feeling good about how far she has come. She is looking forward to the day she can drive again and get back to her normal routine.

"Maria is doing very well, and that speaks to the specialized care that is available at Washington Hospital," Thomas said. "This kind of advanced care used to only be available at university-affiliated hospitals. But Washington Hospital is focused on providing leading-edge technology and personnel."

To learn about the lifesaving programs and services available at Washington Hospital, visit www.whhs.com.